OK, running. Or not? This is the question. Do you "run through" this injury, or rest up until all symptoms have gone?

This is where I've had to go out on a limb. I'd set myself some running goals and had race entries in. Generally speaking I'm not all keen at pulling out of things.

I could find no real good advice anywhere as to how far I should be thinking about running. The SIT could find no reference point for the distances I was contemplating. She was not used to long-distance runners and their mindset - and she didn't know me and wasn't able, at least initially, to judge whether I was being foolish or not. Obviously she wouldn't want her work undoing so I dripfed her with information about my events one at a time in order not to cause alarm.

We were both on a learning curve together here, I think.

My first runs had to be in the middle between therapy sessions. A few days after to recover from the session, but also a few days before the next one because those first runs caused some aggravation and there was no way I was going to let anyone near that tendon.

Took me a good 18 months or more to sort out my AT, bits of sports massage but not as heavy as yours it sounds. Lots of ice buckets. Cold sprays. Switched away from striking with heel to front of foot.

Ignoring that stupid hill run I did on 16 Nov 2010 which in all of the last 15 months was my worst mistake by far -and I'll talk a bit more about it later - my first run since Snowdonia marathon 30 Oct 2010 was a tentative 4 miles on 16 Jan 2011.

Well, I had to be a DNS at my first race for 2011, a 50K a week later. Even I could see the sense in that!!

My SIT was happy about resuming running and was listening to my feedback closely. Her expectation was that it would be sore to start off with, but the tendon should loosen up after a couple of miles and the pain ease off.

It did nothing of the sort - it was moderately painful throughout, with no easing off. By the evening of that day the pain was extreme and swelling huge. The next day though it was back to how it was before the run.

My next run was 11 days later, 8 miles. Again moderate pain until mile 8 when it got much stronger and I finished the run, as I put it in my log, with "loss of form". I also noted I was in "great pain for 36h".

Interesting point Fit-Running-Cat. I would have said forefoot stiking would have made the AT worse, unless you really were transmitting a lot of shock through the heel? Looks like yours was a slightly different and more complex issue.

Great Read and very interesting. I have had a mild version of AT twice over the last couple of years. Since Christmas I have had it again

I have used some of the stretches you describe and especially heel drops Been to a sports therapist a couple of times for massaging.

My current dilemma is to run or not to run. Currently holding off as the last two short runs I did (5k) aggravated it and left me hobbling for a few days so trying to keep fit at the gym spinning and on the turbo trainer both of which seems to ease and loosen the tendon.

I won't bore you with the details of all the runs, except for these initial ones.

Seven days later I was out again for 8 miles. This time "painful during miles 7-8, but no loss of form".

Ten days after that (13 Feb 2011) I was up to 10 miles, when for the first time I noticed the pain eased during miles 3-6.

By the end of February I was up to two runs a week, one short and one gradually getting longer. My first serious target event was 19 Mar so I was really working hard at getting the balance right between running and treatment, and focusing on what was creating improvement. My racing calendar for 2011 was driving me.

So I was doing these things alternately: a run then a torture session, each about two or three days apart.

Trex Heel striking seemed to hurt me so naturally seemed to be the thing to do to avoid that pain. this is before the current barefoot running push came in last few years. As you said with yours, my pace went way down when the AT was bad at this point, very slow, lucky to run once a week 6 miles, bit of football on astro turf, some spinning classes.

Achilles like concrete, hard bony, sore getting up in morning till the blood had been flowing for awhile standing.

Just proving there is no wrong answer and everyone different, of your list of do & don't..Im the opposite view on some of these.I wouldn't exaggerate the movement, very light footed , and force the heel downDitto stairs heel first, I'd go toes/ ball, and avoided shoes/ boots with heels.I wouldnt stand on tip toes, but certainly have done exercises on stairs on tip toes and then down through past the stair level and below..As for sitting/ standing still this was actually a clue for me ,something else sore,legs, hips, whatever. Did some Alexander technique lessons, some interesting things, exercises.

Found my achilles loosen on holiday a few times after swimming in cold sea water, plus resting it sun bathing. Also wearing sandals but you forget this. Later found some cold sprays with menthol loosened it up got in deep and helped a lot.. £1 from a local shop.

Chiropractor spotted that my left hip was 15mm shorter than right. Hence the AT.

Hmm. I admit we all need a maximum range of movement in the ankle when healthy. The trouble with tendonitis is that there is a real threat of tendon and muscle fibres becoming shortened. Contraction such as you describe should be avoided, certainly in the beginning stages of the injury. People with bad cases of AT, such as mine, would not physically be able to do toe raises anyway. Or would compromise themselves by using the good leg.

I always used to think, heel. Use the heel. Keep the tendon warm and stretched. When walking, or sitting, think about keeping the heel placed on the ground. Stretch out the tendon at every available opportunity.

In the second half of Mar 2011 I was having a few setbacks. I noted I was feeling "sore and tired". I had managed one 16-miler, recording "a struggle 13-16" and "sharp pincer-like pain at mile 9".

My warm-up race for 2011 was the Rhayader 20 which I did, recorded "no untoward pain". I was much slower than usual due to the injury and the lack of fitness.

This turned out to be the feature of the entire year! Lack of performance, constant nagging injury, but through it all gradual improvement.

The act of running was itself part of the healing process. Although often difficult at the time, and painful immediately afterwards, a few days later came a little more relief from the pain in the area and a little more reduction in the inflammation.

Something in that (range of movement comment), I tend to sleep with toes alternating between heel straight & stretched out, .. when horse riding the instructor always laughs since Im moving between heel down & heel up., just habit I guess to avoid the pain

Hard to work how bad a case like mine was, certainly Achilles like bone, very sore in mornings, limping badly till blood flowing.

Chiropractor could see my problem within 1 minute examination. Best £20 spent ever with groupon offer for 2 visits. Fixed within 4-5 sessions over 2 months and allowed me to run a marathon within 3 months for first time.

Between that race and my next on 10 Apr I only did one run, which was a 24-miler. I was just about doing the very minimum to still be able to do these events.

Don't try to do a heavy training programme. I didn't.

During this run I noted that "the achilles eased from 14 miles on". My SIT was a little surprised how far I had to go before noting this easing.

I was a little apprehensive on the start line of the Connemara 39.3, Co. Galway, but managed to complete it in just under 7 hours, about 45 minutes slower than normal. In this the achilles eased at 18 miles.

Next up to think about, and to dripfeed my SIT information with, was The Highland Fling 20 days later. This was 53 offroad miles with rocks and tree roots on the West Highland Way. She tried not to look too worried but I think by now she was slowly being drawn in to my madness. But there was more that I wasn't telling her about.

While I was in Ireland running that ultra I fell into conversation with an Irish runner who told me he had been plagued with AT for I think about a year or two and decided to visit Ireland's top surgeon specialising in sports injuries. This chap injected steroids (cortisone) directly into the tendon. He told me he had been symptom free since then, a few years.

Sounded drastic to me, but over five months into my own injury I thought I'd pay a visit to my doctor to see what he thought. He said if a GP injected into the tendon like that he would risk being struck off. The practice is extremely dangerous: it masks the pain and you risk further injury e.g. rupture, or the procedure itself can actually rupture the tendon. GPs wouldn't do it for risk of litigation. SIT was dead against it as well - she thought the body should heal itself.

Whilst at the Drs of course we had a general chat about AT and he printed out some very helpful notes, some of which I've incorporated into what I've said so far.

He also said, "The thing with achilles tendonitis it comes when it feels like it, and goes when it feels like it - there's not much you can do for it". Typical doctors! But he did suggest that I should keep moving and advised me it should be OK to resume my normal level of activity. If he had known I don't think he would consider my "normal level of activity" normal!

Always quite a logistic exercise, this ultra. I camp the night before and get my stuff moved to different places along and at the end of the course.

Set out well enough but somewhere along the shore of Loch Lomond I stubbed my toe very badly. This sent shock waves into the achilles and I suddenly felt a rush of nausea and outrageous pain. Couldn't help the involuntary yelling. I had to stop.

It wasn't a good place to stop. About 20 miles in and still another 8 or so to the next check point, so I tried to hobble on, first walking, then shuffling, before finally breaking into a slow and pained run.

"Better not do that again," I thought. But I did, twice, in the next 20 miles. After the third time I realised it would be curtains if it happened any more times. It didn't, happily.

So, lesson here: be careful about foot placement - no stubbing of toes.

I soldiered on to the end of the course, at Tyndrum. I finished over 2 hours slower than I had ever done this event before, taking over 14 hours, and was nearly at the back.

Previously bookmarked threads are now visible in "Followed Threads". You can also manage notifications on these threads from the "Forum Settings" section of your profile settings page to prevent being sent an email when a reply is made.

Runner's World is a publication of Hearst Magazines UK which is the trading name of The National Magazine Company Ltd, 72 Broadwick Street, London, W1F 9EP. Registered in England 112955. All rights reserved. Runner's World, Part of the Hearst UK wellbeing network